Thinness and mortality.

The relationship of thinness to mortality was examined in White adult members of the Kaiser Permanente Medical Care Program who had at least three multiphasic health checkups between 1964 and 1972, with mortality follow-up through 1980. A detailed comparison was performed of the mortality patterns of "thin" (decile 1 of Quetelet's index) and "average" weight (deciles 4 and 5) cohort members who were age 40-79 years and free of illness at the beginning of follow-up. Thin male (relative risk 1.6, 95 per cent confidence limits 1.0, 2.6) and female (R.R. 2.1, 95 per cent C.L. 1.1, 3.9) current cigarette smokers were at increased risk of mortality compared with average weight smokers. Unmeasured differences between thin and average weight smokers with respect to quantity of cigarettes smoked may have contributed to the apparent association of thinness with mortality in smokers. Thinness was not associated with increased mortality in never smokers and ex-smokers (R.R. 1.0 in men and women). As association of long-term weight loss with mortality was present in thin and average weight men and in thin women.

Psychological questionnaire score, cigarette smoking, and myocardial infarction: a continuing enigma.

The ability of a group of 94 psychological questions to discriminate between men in whom cigarette smoking was associated with increased risk of myocardial infarction and men in whom smoking was not so associated remains puzzling. Further analyses, controlling for reported alcohol consumption and for a questionnaire item that might reflect physical activity, failed to alter this finding. This interaction of the questionnaire responses with smoking was not found with two other major coronary risk factors, serum cholesterol and systolic blood pressure. Believing that these observations may provide (a) a clue to how cigarette smoking affects risk of myocardial infarction, or (b) some means of identifying greater or lesser susceptibility to the effects of smoking, we invite other investigators to join in the pursuit of this matter. A list of ten selected yes-or-no questions with strong interaction with smoking is provided to assist others in studying this phenomenon; these are similar to ten items on the Minnesota Multiphasic Personality Inventory.

Alcohol intake and hypertension.

In several studies, persons drinking relatively large amounts of alcohol were found to have higher average blood pressures. The association between alcohol and blood pressure is not explained by adiposity; reported use of salt, coffee, or cigarettes; or by under-reporting of alcohol intake. We examined 12-year follow-up data on two matched groups of 850 hypertensive patients each; one group reported an intake of at least three alcoholic drinks per person per day, and the other group, fewer than three per day or none. Except for a lower rate of hospitalization for coronary disease, for which alcohol may be protective, cardiovascular complications leading to hospitalization or death had similar frequency in the two groups. These preliminary findings suggest that presumed alcohol-induced hypertension is as harmful as other forms of hypertension. A method for distinguishing alcohol-induced from non-alcohol-induced hypertension in drinkers is needed.

Racial patterns of alcoholic beverage use.

Among 59,766 persons who had routine health examinations in the years 1978 through 1980, the proportions reporting drinking among self-classified racial groups were: white, 89.5%; Latin, 84.8%; Japanese, 81.9%; black, 79.8%; Chinese, 68.1%; Filipino, 63.9%. Reported use of 3 or more drinks daily was similar in whites, Latins, and blacks but was much lower in the Asian groups. Men of all races reported more drinking than women. A large proportion of drinkers in all race-sex subgroups reported use of small amounts of alcohol, and most nondrinkers reported lifelong abstinence. Wine drinking (2+ days/week) was favored over spirits or beer by whites of both sexes and women of most races; beer use was favored by men of all races except white. All race-sex groups reported a strong alcohol-cigarette smoking association. Comparison with data collected 15 years earlier showed a substantial decline in reported proportions of abstainers and heavier (3+) drinkers as well as apparent narrowing of race-sex differences.

Alcohol, tobacco, and hypertension.

In many studies of diverse populations it has been found that persons drinking relatively large amounts of alcohol tend to have higher blood pressures. In the Kaiser-Permanente study of about 87,000 persons, this alcohol-blood pressure association was not attributable to demographic characteristics, adiposity, reported salt use, smoking, or coffee consumption, nor could it be explained by underreporting of alcohol consumption. If the relationship is a causal one, the pathogenesis is not yet established; direct mechanisms or the effects of withdrawal from alcohol are possible explanations. The Kaiser-Permanente data suggest that about 5% of hypertension in the general population may be due to the consumption of three or more alcoholic drinks per day. Alcohol use shows a positive relation to some sequelae of hypertension but not others; the outstanding exception is coronary heart disease which is negatively related to alcohol intake, probably through different mechanisms. In most studies, cigarette smokers have shown similar or slightly lower blood pressures than non smokers. The degree to which this is due to the thinner body build of smokers, on the average, is not well established; nor is the degree to which a stronger negative relation of smoking to blood pressure might be masked by concomitant alcohol use.

A survey of personal habits, symptoms of illness, and histories of disease in man with and without vasectomies.

Using questionnaire information provided by 4.385 vasectomized and 13,155 matched, non-vasectomized men, we found no significant differences between them for a large number of symptoms and diseases, including those of the cardiovascular system. After taking into account differences in their martial status, past smoking habits, and physical activity at work, significant statistical associations of vasectomy with joint pain or swelling, back trouble, and a history of kidney or bladder infection persisted. Our data are inconsistent with the occurrence of large increases in the risks of many important diseases in vasectomized humans.

Physiologic measures in men with and without vasectomies.

PIP: Blood pressure, hematologic and blood chemistry measurements, and serologic tests for syphilis were performed on 4385 vasectomized and 13,155 age- and race-matched, nonvasectomized men who had multiphasic health checkups as members of a large prepaid medical care program in California. The study was carried out from 1977 through 1980. Age distributions of the vasectomized and nonvasectomized men were identical, 33% of both groups being 40 years old or younger, 33% being 41-50, and 34% being 51 or older. 37% of the vasectomized men had their vasectomies 10 or more years before their examination. Systolic blood pressure was slightly but significantly lower and potassium was slightly but significantly higher in the vasectomized group. All other differences were small and not biologically important. These data agree with other studies of vasectomized humans, in which no association of vasectomy with adverse health outcomes, including atherosclerosis, has been found.^ieng

Alcohol use and cardiovascular disease: the Kaiser-Permanente experience.

Earlier studies of Kaiser-Permanente data have indicated that regular use of alcohol is associated with a reduced risk of major coronary events and that regular use of three or more drinks is associated with an increased prevalence of hypertension. A new study of hospitalizations in relation to alcohol use confirms this disparity in relations between alcohol use and cardiovascular disease and suggests that alcoholic cardiomyopathy has a relatively low incidence. An inverse relation between alcohol use and hospitalizations for cholelithiasis raises the possibility of a common pathogenic mechanism linking alcohol to coronary events and cholelithiasis. Overall risk of cardiovascular disease seems lower among users of two or fewer drinks daily than among either nondrinkers or heavier drinkers.

Alcohol and mortality. A ten-year Kaiser-Permanente experience.

We studied 10-year mortality in relation to baseline alcohol use habits among four groups of 2015 persons, well matched for age, sex, race, and cigarette smoking. Persons reporting daily use of two drinks or fewer fared best; the heaviest drinkers (six or more drinks) had a doubled mortality rate, and users of three to five drinks had a mortality rate, and users of three to five drinks had a mortality rate approximately 50% higher. The nondrinkers had a mortality rate similar to that of users of three to five drinks per day. Cancer, cirrhosis, accidents, and nonmalignant respiratory conditions contributed significantly to the excess mortality of the heavier drinkers; coronary disease mortality was significantly higher among nondrinkers. Smoking intensity was a possible factor in the increased mortality of heavier drinkers, but the data were also compatible with the hypothesis that smoking and drinking are synergistic in the production of certain cancers and nonmalignant chronic respiratory illness. Other traits associated with alcohol use or abstinence are possible contributors to the excess mortality of both heavy drinkers and nondrinkers.

Lack of association between cancer incidence and residence near petrochemical industry in the San Francisco Bay area.

Estimated age-adjusted incidence rates for cancer during 1971--77 among Kaiser Foundation Health Plan (KFHP) members living in a portion of the San Francisco Bay area (SFBA) characterized by a heavy concentration of petroleum and chemical industries were compared to estimated rates among KFHP members in the remainder of the SFBA. One hundred fifty-four comparisons were done for 41 selected cancer sites. The number of significant differences did not appear inconsistent with what might be expected by chance alone; furthermore, in most of these instances the so-called exposed area showed the lower rate. These findings provided some assurance that place of residence near petrochemical industries is not associated with increased cancer risk.

Changes after quitting cigarette smoking.

Changes in cardiorespiratory symptoms and coronary disease risk indicators over an average 1 1/2-year period were assessed in 9392 persistent cigarette smokers and 3825 persons who quit smoking between two multiphasic checkups. The prevalence of questionnaire-reported chronic cough fell markedly in subjects who quit a one-or-more-pack/day habit (e.g., from 11.2% to 1.8% in white men, p less than 0.001). However, chest pain, shortness of breath and exertional leg pain showed no consistent improvement in quitters compared with persistent smokers. Weight gain was about 2-3 lbs greater in quitters, but changes in blood pressure were small and not consistent across race-sex groups, nor were there consistent differences between persistent smokers and quitters in trends in trends in vital capacity, cholesterol or prevalence of ECG abnormality. Quitting was associated with increase in serum uric acid levels of about 0.2-0.5 mg/dl and relative falls in hemoglobin, leukocyte count and serum glucose levels, all consistent with smoker-nonsmoker differences previously found in cross-sectional studies. Except for the small increases in weight and uric acid levels, quitting smoking did not appear to increase risk of coronary heart disease by other mechanisms.

Alcohol use, myocardial infarction, sudden cardiac death, and hypertension.

Studying coronary risk factors, this article concludes that: regular use of alcohol may protect against major coronary events; regular use of three or more drinks daily is a probable risk factor for hypertension; the relations of alcohol use to coronary disease, hypertension, and cardiomyopathy are disparate.

Egg counts utilizing trichrome-stained smears from polyvinyl alcohol (PVA)-preserved fecal specimens.

A simple method of making egg counts on fecal specimens is described. It utilizes PVA-preserved stool, yields a permanent stained slide, and is as accurate and reproducible as other methods in common use.

Cigarette smoking habits and urine characteristics: urinalysis abnormalities are more common is smokers, but the reasons are unclear.

Voided urines of 53,000 white and 9,3000 black cigarette smokers and nonsmokers were studied. Proteinuria was found to be commoner in smokers of both races and sexes. Heavy smokers showed proteinuria more frequently than light smokers. Of eight possible explanatory variables, one, alcohol consumption history, showed some interrelationship in that the smoking status-proteinuria association disappeared among heavy drinkers. Stopping smoking was not associated with a relative decline in proteinuria prevalence. Proteinuria associated with smoking did not appear to be indicative of more serious renal disease. There was a smoker-nonsmoker difference in urine glucose response to oral glucose challenge, apparently explained by higher average 1-hour serum glucose values for smokers, of unknown mechanism but partially explained by differences in alcohol usage. Hematuria, bacteriuria, and high urine acidity tended to be more prevalent in smokers, though these relationships were not consistently significant.

Serum glucose levels and alcohol-consumption habits in a large population.

Using information from approximately 100,000 multiphasic check-ups performed in these facilities, we have found an association between alcohol-drinking habits and serum glucose values one hour after an oral challenge with 75 gm. of glucose. There was a positive dose-response relation between reported alcohol intake and serum glucose level over the most common range of alcohol intake. Serum glucose levels were highest in the group who consumed six to eight alcoholic drinks per day. However, among those who said they took nine or more drinks per day, mean serum glucose levels were significantly lower than in the six-to-eight-drink group. These relations persisted when the analysis was controlled for the effects of age, sex, race, adiposity, time since last food intake, time of day, previously known diabetes, and previously known liver disease. A search of the literature failed to uncover a complete explanation for these phenomena.

Alcohol consumption and blood pressure. Kaiser-Permanente Multiphasic Health Examination data.

We studied blood pressure in relation to known drinking habits of 83,947 men and women of three races (83.5 per cent white). Using health-check-up questionnaire responses, we classified persons as nondrinkers or according to usual daily number of drinks: two or fewer per day, three to five per day, or six or more per day. As compared to nondrinkers blood pressures of men taking two or fewer drinks per day were similar. Women who took two or fewer drinks per day had slightly lower pressures. Men and women who took three or more drinks per day had higher systolic pressures (P less than 10(-24) in white men, and less than 10(-12) in white women), higher diastolic pressures (P less than 10(-24) in white men, and less than 10(-6) in white women), and substantially higher prevalence of pressures greater than or equal to 160/95 mm Hg. The associations of blood pressure and drinking were independent of age, sex, race, smoking, coffee use, former "heavy" drinking, educational attainment and adiposity. The findings strongly suggest that regular use of three or more drinks of alcohol per day is a risk factor for hypertension.